Reducing time spent on the Cardiac Intensive Care Unit

Significant improvements have been made on the Cardiac Intensive Care Unit(CICU) in recent months. Here, CICU Lead Nurse Barbara Childs speaks about one particular area of change: long-stay children. “When I came into post in May 2009 we had one or two long-stay patients. Now, medical advances mean we’re able to do more complex procedures, so we get additional patients staying longer.

Children are long-stay if they’re here for more than 10 days. They usually have multiple conditions or very complex surgeries.”

Despite all the expertise, technology and resources available, there were still shortcomings highlighted by parents whose children received prolonged treatment on CICU. So Barbara and her team decided to approach things differently.

“There was no system in place for long-stay children on CICU, so we had a meeting with parents to see what their experience of the unit was like. We wanted to see what we could change, not only to make the parent experience better but also to reduce their stay on CICU.”

Using feedback gathered from families the team started a project to improve the child and family’s experience on CICU and get children out of the unit quicker, in a safe and timely way.

“We’ve been working on the patient’s journey through CICU and a ‘pathway’ was developed by the nurse practitioners.

We now ensure patients get a multidisciplinary team (MDT) and that they’re allocated a lead consultant. We’ve put a system in place to make sure longer-stay children get a specific nurse practitioner and nursing team.

There’s more emphasis now on asking ‘what do we need to get this child home or to a ward environment?’”

This shift in emphasis is showing real results: “We’re thinking more about the family’s needs and that wasn’t in place before. The parents have been involved in giving us advice, which is incredibly valuable.

Recently we had a child in need of home ventilation support discharged from CICU within eight days. Previously this would have taken three months’ preparation. That’s an amazing achievement. That’s teamwork”.

And Barbara believes it’s teamwork that is so crucial to making change happen: “It’s about everyone on CICU wanting to make changes so things get better. The nursing and medical teams have worked together to make these improvements. You need to have good leadership and seek out solutions. For example, if you can’t get a child back to their local hospital, what else can you do to make something happen?

Our team explore all the options together and usually find an alternative. You have to think as a team and bring everyone into that solution otherwise you won’t get everyone on board”.